It is a blow to efforts to line up enough GOP votes to push the legislation through the Senate next week

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Updated: 11:08 AM MDT Jul 15, 2017

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WEBVTT SOLEDAD: I'M SOLEDAD O'BRIEN.WELCOME TO MATTER OF FACT. WHILE THE HEALTH CARE DEBATE HASBEEN DIVISIVE TO SAY THE LEAST-- THE AMERICAN PUBLIC IS PRETTYCLEAR ON WHAT THEY'D LIKE TOSEE.A LITTLE UNITY.A NEW KAISER FAMILY FOUNDATIONPOLL SHOWS 71% OF THE PUBLICWANT A BI- PARTISAN SOLUTION TOTHAT BREAK DOWN INCLUDES 41% OF,AND 72% OF INDEPENDENTS.HOPE OF A GOP ONLY BILL ISFADING AWAY DESPITE THE EFFORTSOF SENATE MAJORITY LEADER, MITCHMCCONNELL.SHOWING HIS FRUSTRATION,MCCONNELL DELAYED THE START OFTHE AUGUST RECESS BY TWO WEEKSIN HOPES OF GETTING TO ACONS>> WE SIMPLY, AS A RESULT OF ALLTHIS OBSTRUCTIONISM, DON'T HAVEENOUGH TIME TO ADDRESS ALL OFTHESE ISSUES BETWEEN NOW AND THEORIGINALLY ANTICIPATED AUGUSTRECESS.SOLEDAD: EZEKIEL EMANUEL, ANARCHITECT OF THE AFFORDABLE CAREACT, SAYS THE LAW NEEDS ANUPGRADE, BUT NOT AREPEAL-AND-REPLACE.DR.EMANUEL OUTLINES HIS IDEAS INHIS BOOK, PRESCRIPTION FOR THEFUTURE. THANKS FOR JOINING US.YOU HAVE BEEN IN MEETINGS AT THEWHITE HOUSE WHILE THE HOUSE WASWORKING ON ITS HEALTHCARE BILL.DESCRIBE FOR ME A LITTLE BITABOUT WHAT THOSE MEETINGS WERELIKE.DR. EMANUEL: WELL, WE WEREDISCUSSING THE SUBSTANCE OFHEALTHCARE AND WHETHER THEREPUBLICAN PROPOSALS WHICH HAVESTAYED LARGELY THE SAME, DESPITESOME TWEAKS, WERE A GOOD IDEA,OR NOT A GOOD IDEA, OR WHAT THEALTERNATIVES MIGHT THE VIABLE.SOLEDAD: SO WERE THOSECONTENTIOU?WERE THOSE IDEAS GOOD IDEAS FROMYOUR PERSPECTIVE?DR. EMANUEL: I HAVE BEEN ON THERECORD SAYING THAT I DON'T THKTHE REPUBLICAN PROPOSALS --FIRST OF ALL, THEY ARE NOTBIPARTISAN AND THEY HADCRITICIZED THE DEMOCRATS FOR NOTBEING BIPARTISAN.NOW THEY HAVE ACTUALLY TAKENBEING PARTISAN A WHOLE OTHERSTEP FORWARD.THEY HAVEN'T EVEN TALKED TO TDEMOCRATS WHEREAS THE DEMOCRATSTALKED TO THEM AND I FIND THEREPUBLICAN PROPOSALS ACTUALLYANYTIME YOU ARE THINKINGTHROWING 22, 24 MILLION PEOPLEOFF HEALTH INSURANCE, NOTSOMETHING VERY APPEALING.MOST IMPORTANTLY AS I POINTEDOUT IN THE BOOK THERE IS NOPROPOSAL OR NO IDEA IN THEIRPROPOSALS TO ACTUALLY CONTROLHEALTHCARE COSTS.THIS MOMENT IN AMERICAN HISTORYIS ABOUT AFFORDABILITY OF THEHEALTH CARE SYSTEM.AND THE REPUBLICAN PROPOSALSDON'T IMPROVE AFFORDABILITY.WHAT I DISCUSS IN THE BOOK IS WENEED TO THINK THROUGH HOW TOACTUALLY REDUCE HEALTHCARECOSTS, BECAUSE THAT IS THE ONLYWAY ON A LONG TERM BASIS TO MAKEHEALTHCARE AFFORDABLE AND THEN IOUTLINE DIFFERENT WAYS THAT THATIS POSSIBLE.SOLEDAD: LET'S TALK ABOUT SOMEOF THOSE DIFFERENT WAYS AND THEOVERALL PHILOSOPHY.HOW DO YOU REDUCE HEALTHCARECOSTS UNDER WHAT ALREADY EXISTSIN THE ACA OR OBAMACARE?DR. EMANUEL: FIRST WE NEED TOREMEMBER THAT 84% OF ALLHEALTHCARE SPENDING IS FORPEOPLE WITH CHRONIC ILLNESSPEOPLE WITH HEART DISEASE,, CANCER, EMPHYSEMA, ASTHMA,DIABETES.WE NEED TO FOCUS ON THOSEPATIENTS.SECOND YOU NEED TODOCTORS AND HOSPITALSDIFFERENTLY TO KEEP THOSEPATIENTS HEALTHY, TO NOT WAITFOR THEM TO SHOW UP AT THEOFFICE SICK BUT TO ACTUALLYREACH OUT TO THEM AND KEEP THEMHEALTHY.SOLEDAD: SO WHAT CHANGES WOULDYOU THEN SPECIFICALLY MAKE TOTHE MARKET PLACES, ETC., ETC?DR. EMANUEL: SO THERE I WOULDSAY ARE FOUR OR FIVE MAJORCHANGES THAT WE COULD DO THATWOULD STABILIZE THE MARKETPLACEAND MAKE THEM MUCH MORETHRIVING.THE FIRST ONE IS THAT WE HAVE TOANNOUNCE THAT WE WILL ACTUALLYGIVE COST SHARING SUBSIDIES.THESE ARE SUBSIDIES TO PEOPLEWHO ARE RELATIVELY FROM AVERAGEINCOME AND BELOW TO HELP PAYTHEIR DEDUCTIBLES AND HELP PAYTHEIR CO-PAYS.INSURANCE COMPANIES ARE WORRIEDTHAT GOVERNMENT WILL NOT PAYTHAT BILL AND THEY ARE GOING TOBE STUCK WITH IT.SECOND, WE HAVE TO GET THISREINSURANCE.SO IF INSURANCE COMPANIES ENROLLA LOT OF SICK PEOPLE, THEY AREACTUALLY COMPENSATED FOR THATAND THAT WAS IN THE BILL, IN THEACA AND SEN.MARCO RUBIO AND SENATEREPUBLICANS STRIPPED IT OUT.THIRD WE HAVE TO ANNOUNCE THATWE WILL ENFORCE THE MANDATE.IT IS THE LAW OF THE LAND,REPUBLICANS SHOULD BE ENFORCINGTHE LAW OF THE LAND AND THATWILL GET MORE PEOPLE INTO THEMARKETPLACES.FOURTH, WE CAN INCENTIVIZEINSURANCE COMPANIES TO GO INTOTHOSE COUNTIES THAT DON'T HAVELOT OF INSURANCE COMPANIES.AND LAST, ADVERTISING TARGETEDAT YOUNG PEOPLE TO TELL THEMHEALTHCARE IS AVAILABLE, IT ISCHEAP, AND THERE IS A MANDATEAND YOU WILL PAY A PENALTY IFYOU DON'T HAVE IT.ASK HEALTH POLICY EXPERTS WHOARE CONSERVATIVE THEY AGREETHESE ARE THE CHANGES WE NEEDAND THEY WOULD DO A HUGEPOSITIVE JOB.THEY WOULD STABILIZE THE MARKETSAND MAKE SURE THAT THEY ARETHRIVING.SOLEDAD: SO YOU ARE HOPEFUL.DR. EMANUEL: OTHAT MAKES ME AN OPTIMIST IS IFYOU GO AROUND THIS COUNTRY,THERE IS A LOT OF INNOVATION, ALOT OF ENTREPRENEURIAL SPIRITAND YOU CAN SEE A LOT OF THESEIMPROVEMENTS ON THE GROUNDMAKING A BIG DIFFERENCE.WHAT WE NEED TO DO OVER THE NEXTDECADE OR SO IS MORE RAPIDLYCHANGE HOW WE PAY DOCTORS ANDHOSPITALS AND LET THESEEXPERIMENTS THAT HAVE SPROUTEDUP AROUND THE COUNTRY REALLYBLOSSOM AND SPREAD AND I THINKTHAT IS THE KEY, AGAIN MY BOOKIS A SMALL ATTEMPT TO TAKE THATAND SHOW PEOPLE SO THEY CANADOPT THESE KINDS OF CHANGES.

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Major insurance groups call part of health bill 'unworkable'

It is a blow to efforts to line up enough GOP votes to push the legislation through the Senate next week

Two of the insurance industry’s most powerful organizations say a crucial provision in the Senate Republican health care bill allowing the sale of bare-bones policies is “unworkable in any form,” delivering a blow to party leaders’ efforts to win support for their legislation.

The language was crafted by conservative Sen. Ted Cruz, R-Texas, and leaders have included it in the overall bill in hopes of winning votes from other congressional conservatives. But moderates have worried it will cause people with serious illnesses to lose coverage, and some conservatives say it doesn’t go far enough.

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Two of the 52 GOP senators have already said they will oppose the legislation. Senate Majority Leader Mitch McConnell cannot lose any others for the legislation to survive a showdown vote expected next week.

The overall measure represents the Senate GOP’s attempt to deliver on the party’s promise to repeal President Barack Obama’s health care law, which they’ve been pledging to do since its 2010 enactment.

The criticism of Cruz’s provision was lodged in a rare joint statement by America’s Health Care Plans and the BlueCross BlueShield Association. The two groups released it late Friday in the form of a letter to McConnell, R-Ky.

“It is simply unworkable in any form,” the letter said. They said it would “undermine protections for those with pre-existing medical conditions,” increase premiums and lead many to lose coverage.

The provision would let insurers sell low-cost policies with skimpy coverage, as long as they also sell policies that meet a stringent list of services they’re required to provide under Obama’s law, like mental health counseling and prescription drugs.Cruz says the proposal would drive down premiums and give people the option of buying the coverage they feel they need.

Critics say the measure would encourage healthy people to buy the skimpy, low-cost plans, leaving sicker consumers who need more comprehensive coverage confronting unaffordable costs. The insurers’ statement backs up that assertion, lending credence to wary senators’ worries and complicating McConnell’s task of winning them over.

The two groups say premiums would “skyrocket” for people with preexisting conditions, especially for middle-income families who don’t qualify for the bill’s tax credit. They also say the plan would leave consumers with fewer insurance options, so “millions of more individuals will become uninsured.”

According to an analysis by the BlueCross BlueShield Association, major federal consumer protections would not be required for new plans permitted by the Cruz amendment.

Among them: guaranteed coverage at standard rates for people with pre-existing conditions, comprehensive benefits, coverage of preventive care — including birth control for women — at no added cost to the consumer, and limits on out-of-pocket spending for deductibles and copayments.

The bill provides $70 billion for states to use to help contain rising costs for people with serious conditions. But the insurance groups’ statement says that amount “is insufficient and additional funding will not make the provision workable for consumers or taxpayers.”

The Cruz provision language in the bill is not final. McConnell and other Republicans are considering ways to revise it in hopes of winning broader support.McConnell and top Trump administration officials plan to spend the next few days cajoling senators and home-state governors in an effort to nail down support for the bill.

The nonpartisan Congressional Budget Office is expected to release its analysis of McConnell’s revised bill early next week, including an assessment of Cruz’s plan.The office estimated that McConnell’s initial bill would have caused 22 million additional people to be uninsured.